the number of diabetics, giving policy makers, health care providers,

and taxpayers all cause for concern.

“Once largely the province of the upper classes, non-insulin-

dependent diabetes today crosses all economic strata,” observed

John Potter, Senior Vice President and Director of Public Health

Sciences at the Fred Hutchinson Cancer Research Center. “The

ubiquity of soft drinks, for example, is an indication of historically un-

precedented sugar consumption worldwide. Still, diabetes does not

result strictly from individual behavior so much as from a combina-

tion of societal and economic conditions.”

Reasons for the rise of diabetes and

other obesity-related illnesses around

the globe include decreases in physical

activity as technology enables people to

live more sedentary lifestyles. Addition-

ally, the widespread consumption of

food rich in saturated fats and refined

sugar in societies where rice, vegeta-

bles, and fish have been the mainstay

has exacerbated the trend.

In developing countries, the combination

of underweight children and overweight

adults is becoming more widespread—especially in countries

experiencing a socioeconomic and demographic transition. Rapid

changes in diet, food availability, and lifestyle that occur at a fast

pace are drastically affecting regulatory system development. When

people who have subsisted on a modest, relatively healthy diet for

generations are exposed to an unrestricted dietary energy sup-

ply, they become more susceptible to obesity and its associated

illnesses.

Addressing the link between obesity and lifestyle, Diane Finegood,

Science Director at the Canadian Institutes of Health Research’s

Institute of Nutrition, said it is important to design social environ-

ments to encourage more mobility and better access to healthy

foods. Currently, the physical work and play environments of mod-

ern society tend contribute to unhealthy lifestyle choices. By re-engi-

neering workplaces to replace vending machines options with more

healthy beverage options, designing office buildings where stairs

are easier to find than elevators, and encouraging the creation and

* http://www.who.int/topics/obesity/en/

Fighting Fat - How Do We Prepare for the Global Obesity Epidemic?

Breakout Session Report

John Potter

The World Health Organization estimates that there are currently

1.1 billion people who are overweight and that this number will

exceed 1.5 billion by 2015.* In addition to serious health conse-

quences of obesity–such as increased cardiovascular disease,

cancer, diabetes, and arthritis–the direct economic costs have been

estimated to account for between 2 percent and 7 percent of total

health care costs. And the global trend toward weight gain and its

associated illnesses is not restricted to the well-off. The develop-

ing world’s obesity problem could become both public health and

economic disasters in some countries.

A grim picture, indeed. But is it inevitable? Not necessarily. Because

obesity is both a medical condition and a lifestyle disorder, behavior

has a big influence on outcomes.

In response to growing concern about the obesity epidemic and

rising tide of concomitant illnesses, the 2006 Pacific Health Summit

“Fighting Fat” breakout session addressed key questions such as:

• How do we stem the tide of obesity and other

diseases linked to diet or physical activity,

such as diabetes, heart disease, osteoporosis,

and malnutrition?

• What can science and policy do to prepare for

the heavy disease burden in both developing

and developed societies?

• How can we change behavior to counteract

these trends?

• What role can the medical industry and

government play?

Robert Rizza, President of the American Diabetes Association,

opened the session with an outline of the financial cost of the obe-

sity epidemic. In the near future, he estimated, the world will spend

over $6 trillion on treating diabetes—one of the most common

consequences of obesity. A manageable chronic disease in the de-

veloped world, diabetes is lethal in poor nations where most people

lack access to insulin injections and regular monitoring capabilities.

Mingzhe Chen, Vice Dean of Tsinghua University Medical School,

added that China has experienced an especially worrisome jump in

planning of communities where walking or biking is more convenient

than driving a car would help individuals make behavioral changes

that could benefit their health.

Paul Robertson, CEO and President of the Pacific Northwest Re-

search Institute, agreed that efforts to encourage healthy behavior

are our best defense against rising diabetes rates. Positive reinforce-

ment for healthy lifestyle choices could help reverse recent trends in

obesity.

“Fat is the new tobacco,” Finegood said. When the non-smoking pub-

lic began to assert its smoke-free rights, smoking gradually dropped

to pariah status helping to reduce the social pressure to smoke.

Once non-smokers began insisting on clean air in the workplace,

restaurants, and bars, making healthy choices regarding smoking

became easier.

J. Edward Hill, Immediate Past President of the American Medical

Association, stressed the importance of early intervention, especially

for children. There is an 80% chance that habits children develop be-

fore age eight will be permanent. In order to instill positive behavior

early on, parents and schools should actively address and promote

nutrition, healthy lifestyle choices, and physical activity at the early

childhood stages. While comprehensive health education initia-

tives for parents and children do exist, most do not reach deeply or

broadly enough. Education must reach beyond homes and schools

into general culture and society in order to the impact that is possible

and necessary.

Encouraging healthy behavior would

not only improve the health of the popu-

lation, Robert Rizza added, but it would

also save money. The United States

alone could save $325 billion annually

if it tackled the obesity epidemic in the

early stages, before it brought on diabe-

tes and other diseases.

But how do we influence behavior and

lifestyle choices? Peter Singer, Sun

Life Financial Chair and Director at the

University of Toronto, suggested that

financial incentives might help. Since

foods rich in sugar and saturated fat are often much cheaper than

healthy food, subsidies to decrease the cost of organic and fresh

food might make a difference.

Tax deductions for fitness center, sports club, and Weight Watchers

membership could also motivate people to change their behavior.

Finally, improved nutrition labeling in developing and developed

countries alike would enable people to make healthier choices.

The bottom line is that obesity is a structural, social problem, as

well as a genetic problem. The challenge, for the most part, is lack

of attention—from policy makers, doctors, educators, parents, and

individuals in general.

In addition to en-

couraging healthy

individual behavior,

participants noted

that advances in

pharmacology could

also help decrease

diabetes cases.

Drugs that treat the

disease will become

more effective and

less expensive in

the near future. Making these drugs affordable and accessible in the

developing world will be a formidable challenge to tackle.

According to Paul Robertson, “Diabetes and obesity are ‘Rodney

Dangerfield diseases’—they get no respect.” The general population

is insufficiently aware of the risks or consequences of either, and

there is inadequate interest in focusing resources on this problem at

the state and federal levels. This lack of interest translates into a lack

of funding for new and ongoing research.

Ultimately, increasing awareness will inspire change at other levels—

individual, social and governmental. As we build awareness about

the problem, motivation to modify our behavior and relationship with

the environment, as well as more willingness and energy from policy

makers and other leaders to invest in order resources to fuel such

change, will increase.

How do we encourage healthy choices?

• Design social environments to encourage more mobility and better access to healthy foods.

• Subsidize organic/fresh produce.

• Offer tax deductions for memberships in fitness centers, sports clubs, and organizations such as Weight Watchers.

• Improve nutrition labeling in developing and developed countries.J. Edward Hill

Peter Singer

To learn more about the Pacific Health Summit, please visit

www.pacifichealthsummit.org, or email ctopal@nbr.org.